Teach Teens About Emergency Contraception

The use of emergency contraception can reduce risk of pregnancy up to 120 hours after unprotected sex, however, it's most effective if used within 24 hours after intercourse, says the American Academy of Pediatrics.

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MONDAY, Nov. 26, 2012 (MedPage Today)
— Pediatricians should counsel all adolescents on use
of emergency contraception, such as Plan B, as part of routine practice,
according to an American Academy of Pediatrics (AAP) policy
statement.

Healthcare professionals should provide teens with an education on the
use, availability, and advance prescription of emergency contraception, as well
as contraindications and adverse events related to different forms of emergency
contraception, according to the statement drafted by Krishna Upadhya, MD, Cora
Breuner, MD, and colleagues of the AAP Committee on Adolescence.

"The discussion of emergency contraceptions methods with patients
must also include the fact that none of these methods will protect from sexually-transmitted
infections," they wrote online in the journal
Pediatrics.

The authors noted that despite significant declines in teen birth
rates over the past two decades, birth rates remain "significantly higher
than other industrialized nations." The use of emergency contraception can
reduce risk of pregnancy up to 120 hours after unprotected sex or in the event
of contraceptive failure, though forms of emergency contraception are most
effective if used within 24 hours after intercourse.

They also noted that teens are "more likely to use emergency
contraception if it has been prescribed in advance of need."

The policy statement recommended three methods of emergency
contraception, including levonorgestrel (Plan B), ulipristal acetate, and the
Yuzpe method, which involves use of combining oral hormonal
contraceptives.

Plan B requires patients to take two 0.75 mg levonorgestrel tablets 12
hours apart or a single 1.5 mg dose, which may be "equally effective and
without increase in adverse effects." The drug is contraindicated in
patients who are known to be pregnant and may cause adverse events of nausea,
vomiting, and heavier menstrual bleeding. Patients should take a pregnancy test
if they do not have a normal period within 3 weeks of using Plan B.

Ulipristal is a single pill (30 mg) that prevents binding of
progesterone and should be taken within 120 hours after unprotected sex.
Adverse events include headache, nausea, and abdominal pain. Patients with
existing pregnancy should not take ulipristal due to risk of fetal loss, and
use may require a pregnancy test. Patients with severe abdominal pain 3 to 5
weeks after treatment should be evaluated for ectopic pregnancy.

The Yuzpe method requires patients to take two doses of at least 100
μg of ethinyl estradiol and at least 500 μg of levonorgestrel and can be useful
for patients with "no or limited access to an emergency contraception
product." Though the use is considered off-label, the statement noted that
the combination oral contraceptive use has been declared safe and
effective.

Adverse events with the Yuzpe method include nausea and vomiting,
fatigue, breast tenderness, headache, abdominal pain, and dizziness.
Antienimics may offset the effects of nausea and vomiting with this method if
taken an hour before administration. This method should not be used by patients
with a contraindication to estrogen use.

In addition to informing patients about emergency contraception use,
pediatricians should encourage both male and female patients to get tested or
treated for sexually transmitted infections and discuss ongoing contraception
methods following use of emergency contraception.

The authors also noted that, at the policy level, "pediatricians
should advocate for increased nonprescription access to emergency contraception
for teenagers regardless of age and for insurance coverage of emergency
contraception to reduce cost barriers."

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